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By Susana Correia

Created: 23 November 2014

It's 4 AM and I can't sleep.  I'm thinking about how much I still need to get done before wrapping up my volunteer stint here in Bhimphedi, Nepal in 10 days.  I have to write this blog post and a publishable case study, which I still haven't picked out yet.  All this while treating a ton of patients 6 days per week and trying to spend time with the beautiful friends that I've made here.   I'm mad for letting myself get back to this state of unease and sad for the heavy loss I'm about to experience.  

Coming to Nepal, I assumed I would have a somewhat stressful and uncomfortable "third world" experience.  And when I first arrived, it took a while to adjust to the time change and environment.  I had terrible insomnia, bowel issues, breathing problems and I was anxious about starting my work in the clinic.  The first week in clinic was slightly overwhelming.  Although I only treated 7 people my very first day, I still felt frazzled.  I did not realize how serious the conditions would be that I would be expected to diagnose and treat.  I am definitely way more than an acupuncturist here.  I am a primary care doctor.  Im finally getting used to saying that and believing in my ability to be just that.  It is now not nearly as daunting to treat someone with a massive oozing non-healing sore, tonsillitis, uncontrolled hypertension, paralysis or diabetic neuropathies.  The possibility of someone coming in with tuberculosis, fungal infections and typhoid fever does not freak me out nearly as much anymore.  Just another day in the clinic.  

Even out of the clinic, I no longer feel like I have a chronic case of the cooties.  When I get bit by a mosquito, I no longer think "I hope I dont get malaria."  And when I see a piece of chicken poop, I dont necessarily think, "Is that a leech?"  I stopped using hand sanitizer every 5 seconds.  I dont guzzle grapeseed extract everyday either.  Maybe I won't actually contract a major disease here. Just maybe.  

It was the 7th day of clinic when I finally started to feel my rhythm.  I had a bunch of return patients that day, so the interpreters labeled it "Susana Day."  I was in awe of how these people were trusting me with their health and actually getting better.  That helped build my confidence and ease my anxiety.  I was cleaning wounds, checking glucose levels, using an otoscope to check for ear infections, working with infants and kids with disabilities.  I'm not saying my treatments have been perfect, but I can say that I am providing attentive and thoughtful healthcare and truly connecting with my patients.   

After the first week or so, and settling into a simple routine here, I realized that I was the happiest and most peaceful that I had been in years.  I wake up early, go for my walk to the look-out point above the river, do some qi gong and yoga.  I get back home to eat a simple breakfast that Auntie makes in her outdoor kitchen, and head off to clinic.  I work from 8:30 am to 4:30 pm, with a quick lunch of Dahl Baht.  When I get off work, I take a quick rinse off in the outdoor shower/ spicket and finish my charting while waiting for Auntie to provide us with another plate of spicy Dahl Bhat for dinner.  I go to bed super early and wake up in the middle of the night to go pee in the outdoor squat toilet.  Six door latches later and I usually have a hard time getting back to bed.  Thats when I ruminate over my patients.  Then I get up and start all over again.  

I am certain now that I am happiest with a simple life and a regular schedule.  Back home in Brooklyn NY, things have not been so simple.  The last 4 years were dedicated to intensely studying Chinese medicine while working, barely socializing and commuting around a hectic city.  I did not realize just how much my irregular busy schedule was wearing me down.  

Aside from my clinic experience, I have also had other pretty epic adventures.  I've visited many holy sites for both Hindus and Buddhists.  But that is not limited to the myriad of temples and stuppas that are everywhere.  The land here is thick with spiritual history and energetic density.  While trekking in Langtang National Park, I climbed the highest I've ever climbed (almost 16,000 feet) and visited lakes and rivers that were created by Shiva himself.  I hitched a ride on the crowded rooftop of the local bus up to Kogate to celebrate Tihar, the Hindu Festival of Lights.  I was blown away by the density of spirit in this remote mystical shire that has the most spectacular views I have ever seen.  (Kogate has since become my happy place.)  Between all the gods and goddesses, witches and shamans, you feel a spiritual energy here like nowhere else I've felt.  

There's been a lot of clarity for me here in Nepal.  Following a simple routine in this special place has helped reconnect me with my true self again, a calm and content being.  I chose to come to Nepal without knowing hardly anything about where I was actually going.  Somehow I just felt it was where I needed to be.  And I was right.  What was supposed to be a stressful "third world" experience turned out to be one of the most peaceful and happiest moments in my life.  

In the last 3 days I have treated 64 patients, 55 of those are my regular patients.  Even though Im pretty exhausted by the end of the day, providing healthcare does not stress me out.  It's having deadlines and taking on too many tasks and responsibilities that disrupts my spirit.  Although I have seen the light again here, I need to take that light into everyday life, especially going back to NYC, the land of complexity and excess.  My intention is to set up a simple life, slowly build a community-inspired acupuncture practice, and be creative and healthy.  All I really need is healing, music and creativity.  I'm making a promise to myself to keep it simple, stick to a regular schedule and get into nature as often as possible to feel its peaceful energy and let it always remind me of who I really am. ---Susana Correia    

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By Amanda Johnson

Created: 21 November 2014

In that instant, when you’re sandwiched between a motor bike on your right, its passengers shirt tail grazing your arm, a gutter filled with unidentifiable sludge on your left, and an oncoming taxi crammed with 12 Nepalese wildly speeding toward you, you start to re-evaluate the meaning of chaos.

How do these millions of people survive in the streets of Kathmandu with no road lines, lights, stop signs or any apparent rules of the road?Cars, vans, bicycles, pedestrians, tuk-tuks and animals all playing a calculated game of frogger. It’s fastinating to watch – unnerving at times- but strangely beautiful.

I’ve learned to enjoy the thrill of going on a harrowing taxi ride, like a child enjoying rollercoasters….or a fight against incontinence!

It occurs to me that perhaps why there are not many accidents (that I’ve seen) is because people are in the flow of the moment here. Not generally distracted by phones, eating in the car, putting on make-up – all the things I see far too frequently in the USA. Biking around Portland I get to watch many drivers – and a shocking number are not actually looking at the road. It’s insanity! Maybe the comfort of road lines, lights, signs has put us on auto-pilot. Our ability to take in our surroundings, to be sharp and reactive, declines. We kill people because we can’t wait to send a text?! WHAT!?

Maybe it’s love that saves lives and prevents accidents in Nepal. I have been reading the book Shantaram, a story about an Australian fugitive who escapes from prison to the slums of India. In the story, a character explains why millions of people can manage to live in relative peace together in India is because no one loves like Indians. It’s this collective love for each other that keeps people from freaking out over the claustrophobic conditions, lack of resources and general chaos. I believe this law of love, if you will, applies in Nepal.

Nothing is done alone here, potentially using the toilet is your one moment of precious privacy…potentially. People live with multiple generations of family. They walk, shop, eat, laugh, yell, cry, smoke, drink, sit on stoops together. Contrast this to the typical American, for whom it can be a struggle to car pool with another person. There’s an ingrained sense of independence in Americans. I can do this, not we can do this. Perhaps the Nepalese culture of sharing, of interdependence, plants the seeds for love to grow. I have come to know the warm love of community in Kogate, being immediately embraced as a sister and daughter into my host family. My walk to the clinic each morning is enriched by a “Namaste!”, a smile, a familiar nod. I feel as cared for by them as, I hope, they feel cared for through my work.

There are millions of people and animals, moving as an amoeba, depending upon each other for survival. Horns blaring here and there, not out of anger, but seemingly (again this is not my culture, so I’m speculating) to alert another of your presence. “Hey! My taxi is 1 inch from your foot, excuse me, I don’t want to crush you!”. A courtesy. When horns blare in the U.S. they’re usually followed by a violent gesture, yelling, or at least some dramatic facial gestures from the driver. I am thankful horn on horn violence is a rarity in Portland :)

So next time I’m feeling late for work, stressed about the pace of traffic, ruffled by the inevitable obstacles set before me, I’ll try to be part of the ameoba. Give thanks for the protective bubble of my car, the safety of the sidewalk, the rules of the road that, theorically, allow me to put on make-up while driving. But of course I won’t! ---Amanda Johnson

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By Marian Klaes

Created: 20 November 2014

My experience with the Acupuncture Relief Project began after reading an article in an Acupuncture newsletter.  The information on the website described it as a cultural immersion and it truly lived up to that description.  As a participant we lived with a local resident and learned what is like to be part of the local culture and live the lifestyle of the  residents  in Bhemphedi, Nepal.  

I found the people of Nepl to be a very gracious culture.  At one point I had commented to an interpreter that I was so impressed with how kindly  we were being treated and he responded that we are guests of Nepal and that is how guests should be  treated.  There was never a time we felt unwelcome - whether we were working, trekking, or walking through the village, everyone was kind and respectful.  I found particular delight in the young children I encountered on my daily walks or coming home from the clinic.  The would shyly say Nameste, then say hello.  They would giggle with delight when I said Hello back to them.  They were so excited to know their English had been understood and would say  hello and goodbye repeatedly just to have me answer them.

Our team stayed with a delightful lady we called Auntie.  We stayed at her house which consisted of  four  bedrooms.  The remainder of the house consisted of an outdoor kitchen, outside bathrooom and outside shower.  Aunti was a gracious host who worked hard serving three substantial meals a day for six to twelve people.  All cooking was done on two propane burners as there are no ovens or electric/gas ranges.   There are no luxuries in Nepal -  appliances that  we consider  normal and essential  such as  microwaves,  washing machines,  clothes dryers, and dishwashers are not available in the rural villages.  Electricity would go out with no warning and there was never rhyme or reason when it would go out or how long it would stay out.  The Nepalis, used to it happening, would go about their business as they were accustomed to such interruptions.  

The work at  the clinic was busy and intense. We saw many different conditions usually related to  lifestyle.  Farming is mostly done by manual labor, women and children carry extremely heavy loads on their backs and necks.   The country is steep  and everyone walks on narrow and rocky paths often carrying large  loads of vegetables, firewood and staples such as rice and lentils.  The lifestyle contributes to back, neck and knee problems which were common ailments treated at the clinic.  Numerous other condtions such as stomach pain, menstrual disorders, stress and skin conditions were seen and it was gratifying  to see so many  respond to acupuncture treatment.  Seeing the reults of the treatments  has inspired me to return home and work with patients in my private practice.

When it rained the electricity would go out and the rain would come through the roof at the clinic. Patients would get wet yet they never complained. They were all appreciative that we  came to volunteer and they would sit in the cold, rain, or whatever to take advantage of health care services.  Heath care in Nepal is limited to non-existant.  There is no such thing as health insurance and any services are always out of pocket expense.  Employment opportunities are very limited and most people cannot afford to pay for care.  The ARP project is staffed by  volunteers and  patients pay nothing for the services.  Patients repeatedly thanked the team for what we provided and  would bring in vegetables ,  freshly made mustard oil or other gifts out of appreciation.   They would walk  or ride the bus one, two or three hours to come to the clinic and it was not uncommon for them to have to wait an hour or two before being seen. They were always gracious and never complained about the wait -they were just grateful for a chance to get some help.

As part of the experience I learned a lot about life in Nepal and In general it is a very hard life.  Women and children carry heavy loads on their backs to provide feed for animals or wood for a fire.  Central heat or air is not an option.  We trekked in the area where it is very cold and the only way to get supplies there is by humans, horses or yaks.  Food is limited in supply and in  variety.  We stayed in small tea houses along the way and the owners were always gracious hosts and willing to share a warm  fire  in the very cold evenings.  The rooms were unheated, the bathroom were outside and unheated and I thought about how much colder it would get in the coming months.  I knew I would be home with my central heat  and they would still be there with nothing but a  clay cooking stove to provide heat and cook their meals.  Yet the guest houses were always warm and welcoming in attitude and in service.

Educational opportunites are also limited in Nepal and I met  many young people who valued the opportunity to attend school.  Any chance for an education is appreciated.   School is held six days a week and students often walk great distances to attend.  There are no school buses - any season, any weather, and  they walk to class as they know the more they learn the better the possibility of having a better life than their parents.   

The interpreters at the clinic were young {18-25} and absorbed all they could from the doctors.  The clinic where I volunteered was located in Bhemphedi although two nights  I stayed in the village of  Kogate as  ARP has a satellite clinic there.  One of the family members was a beautiful and enthusiastic young lady, Riesta,  who wanted to read to me.  I had a book on my computer  tablet and she jumped at the chance to practice her reading and verbal English skills.  At one point there was a statement in the book about life is not Disneyland.  What is Disney land she asked?  The conversation that followed found me searching for words to describe cartoons, amusement parks, Disney movies and many other subjects.  It is challenging to explain those things to someone who has no concept of those experiences are like.  She wanted to know all about America - politics, college, entertainment.  the list was endless and she was a captiated listener as I attempted to explain and answer questions.  She told me she was headed to college soon - she would take her backpack, take the bus, and go to a different town where her sister lived.  College with only a backpack?  I was amazed - not quite the experience for students in the States.

The second night Riesta came to read to me, she brought a small container of chocolate, dried coconut pieces and other treats.  They were in a small container with a ribbon and she carefully unwrapped the ribbon and wanted to share.   I looked at the container which held small candies and I knew they  must have been a special gift for her. They were unlike anything I had seen in our local village - definitely something out of the ordinary.  For Americans sweets like that are common, but for her it was something unusual and special.  I initially declined saying I didn't want to ruin my dinner and she seemed so disappointed and hurt.  I agreed to take her offer and she seemed so happy that I did.  Her kindness and generosity was so very touching as here was someone willing to give when she obviouly had so little.  This experience  exemplified the Nepali culture in general.  They are generous, gracious and caring and would share whatever they had even if it means they go without.

I listened to young people talk about their dreams and aspirations of traveling or having careers as  fashion designers or journalists.     It is an eye opening experience to relieze how much is available to the average American.   If we want to  travel,  go to college or pursue a specific career it is always an open door.  We do not have the limitations and obstacles that exist in Nepal.  It was hard watching their glowing eyes as they spoke - yet wondering if any of them will ever achieve their goals.   It was inspiring listening to their hopes and dreams but at the same time it was emotionally wretching knowing the reality of the situation. Many expressed to me their desire to visit the Staes as they view it as a place of great opportunity.  Their views made me appreciate so much what we have and expect and how much we  take for granted.  Employment in Nepal is extremely narrow and many leave the country to pursue employment wherever they can, often in low paying jobs but they feel so fortunate to be working they take any job available.

Everywhere I went in Nepal I was asked how I liked their country, how was my stay, what do I think?  Everyone takes great pride in their country and so much wanted the "guests" to enjoy their stay.  They wanted our group to feel at home and welcome and appreciate what the country has to offer.    In the end, my  life in in  Nepal has been challenging, educational and enlightening, and  will always stand out as a memorable rewarding experience. ---Marian Klaes